Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review

Implementation Science

Research

Rachel C. Shelton¹  Nathan M. Solbak²  Alix Hall³  Nicole Nathan³  Janet A. Curran⁴  Shewit Buzuayne⁵  Celia Laur⁶  Noah Ivers⁷  Zeenat Ladak⁸ 

[1] Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, Alberta, Canada;Health Quality Programs, Queen’s University, 92 Barrie Street, K7L 3N6, Kingston, ON, Canada;School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia;National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia;Hunter Medical Research Institute, New Lambton Heights, NSW, Australia;Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia;School of Nursing, Faculty of Health, Dalhousie University, B3H 4R2, Halifax, NS, Canada;Women’s College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, M5S 1B2, Toronto, ON, Canada;Women’s College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, M5S 1B2, Toronto, ON, Canada;Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, M5T 3M6, Toronto, ON, Canada;Women’s College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, M5S 1B2, Toronto, ON, Canada;Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, M5T 3M6, Toronto, ON, Canada;Department of Family and Community Medicine, University of Toronto, 500 University Ave, M5G 1V7, Toronto, Canada;Women’s College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, M5S 1B2, Toronto, ON, Canada;Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, M5S 1V6, Toronto, ON, Canada;

关键词: Audit and feedback;    Sustainability;    Spread;    Scale;    Implementation;    Systematic review;   

DOI  :  10.1186/s13012-023-01312-0

 received in 2023-05-19, accepted in 2023-10-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAudit and feedback (A&F) is a widely used implementation strategy to influence health professionals’ behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale.MethodsThis is a theory-informed, descriptive, secondary analysis of an update of the Cochrane systematic review of A&F trials, including all trials published since 2011. Keyword searches related to sustainability, spread, and scale were conducted. Trials with at least one keyword, and those identified from a forward citation search, were extracted to examine how they described sustainability, spread, and scale. Results were qualitatively analyzed using the Integrated Sustainability Framework (ISF) and the Framework for Going to Full Scale (FGFS).ResultsFrom the larger review, n = 161 studies met eligibility criteria. Seventy-eight percent (n = 126) of trials included at least one keyword on sustainability, and 49% (n = 62) of those studies (39% overall) frequently mentioned sustainability based on inclusion of relevant text in multiple sections of the paper. For spread/scale, 62% (n = 100) of trials included at least one relevant keyword and 51% (n = 51) of those studies (31% overall) frequently mentioned spread/scale. A total of n = 38 studies from the forward citation search were included in the qualitative analysis. Although many studies mentioned the need to consider sustainability, there was limited detail on how this was planned, implemented, or assessed. The most frequent sustainability period duration was 12 months. Qualitative results mapped to the ISF, but not all determinants were represented. Strong alignment was found with the FGFS for phases of scale-up and support systems (infrastructure), but not for adoption mechanisms. New spread/scale themes included (1) aligning affordability and scalability; (2) balancing fidelity and scalability; and (3) balancing effect size and scalability.ConclusionA&F trials should plan for sustainability, spread, and scale so that if the trial is effective, the benefits can continue. A deeper empirical understanding of the factors impacting A&F sustainability is needed. Scalability planning should go beyond cost and infrastructure to consider other adoption mechanisms, such as leadership, policy, and communication, that may support further scalability.Trial registrationRegistered with Prospero in May 2022. CRD42022332606.

【 授权许可】

CC BY   
© The Author(s) 2023

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